Provider Demographics
NPI:1821718339
Name:KELLY SNOW THERAPY PLLC
Entity Type:Organization
Organization Name:KELLY SNOW THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PLLC
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW-HEINZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-229-4920
Mailing Address - Street 1:332 W LEE HWY # 237
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2428
Mailing Address - Country:US
Mailing Address - Phone:540-229-4920
Mailing Address - Fax:
Practice Address - Street 1:8452 RENALDS AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:VA
Practice Address - Zip Code:20115-3755
Practice Address - Country:US
Practice Address - Phone:540-229-4920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701010251OtherLPC LICENSE
VA1942892054OtherNPI 1
VALICENSEOther0701010251